Figure 1. Contrast enhanced abdominal CT scan: coronal section. This image demonstrates the ovoid hypodense filling defect in the IVC distal to the renal veins. The thrombus is expanding the cava (red circle). Note also the hypodense metastatic deposit in the liver (green circle).

This case report identifies an IVC thrombosis in a patient with stage IV prostate cancer. The case demonstrates hypercoagulability as one of the many complications of malignancy. The patient presented clinically with bilateral pitting oedema to the groin and into the scrotum with dilated superficial abdominal veins. The prostate cancer was aggressive and unresponsive to anti-androgen therapy and brachytherapy. The latest staging CT and bone scans revealed diffuse disseminated disease and a caval thrombus. He is now receiving chemotherapy as an outpatient and unfortunately his prognosis is unfavourable.

Figure 1. Right fundus of Case One, eighteen months prior to the time of presentation with decreased left visual acuity. A vitelliform macular lesion typical of Best disease is present.

Juvenile Vitelliform Dystrophy (Best disease) is a degenerative macular condition that is genetically inherited. In recent years monoclonal antibodies have been employed to help prevent the decline in vision associated with macular fluid. This report documents the use of intra-vitreal bevacizumab in two siblings (aged thirteen and fifteen) with Best Disease. This work studies the changes observed in visual acuity and macular oedema over a 39 and nineteen week period respectively.

Introduction: This case report aims to address the ethical issues and obligations of enforcing medical care onto psychiatric patients under the Queensland Mental Health Act 2000 Involuntary Treatment Order (ITO), and will also present Queensland’s legal standpoint and limitations on providing this care under the Act. Case Presentation: PF, a 47 year old male with a history of depression and recent diagnosis of Gleason 7 prostate cancer was admitted to the acute mental health unit following an intentional overdose of alprazolam. His risk to himself prompted the application of an ITO. Although PF was due for investigation of his recently diagnosed prostate cancer, he refused following his suicide attempt. Conclusion: Although an ITO allows for enforcement of psychiatric treatment, no legal allowances exist for enforcement of medical care. In situations where medical conditions may be indirectly detrimental to a person’s mental health, ethicallyappropriate techniques should be employed.

This case report describes a lady who presented with abdominal pain, hypotension and multiple ovarian follicles following egg collection and embryo transfer. She was provisionally diagnosed with Ovarian Hyperstimulation Syndrome (OHSS) and managed accordingly. This case study describes her clinical presentation, investigations, progress, management and outcome. No current laboratory diagnostic/prognostic markers are available for OHSS; the condition is currently diagnosed clinically. The subsequent discussion elaborates on the epidemiology, pathophysiology, clinical features, assessment, management and risk factors of OHSS, and aims to increase awareness of this important complication of infertility treatment to assist diagnosis, prevention and early institution of treatment.

Intraoperative cholangiogram during a laproscopic cholecystectomy

Abstract

Iatrogenic bile duct injury (BDI) is a known complication of laparoscopic cholecystectomy with serious consequences for the health of the patient. Intra-operative cholangiogram (IOC) has been shown to reduce the incidence of a major BDI, and is currently used routinely by the majority of surgeons in Queensland. This case report details the use of a ‘retrograde IOC’ for the detection of a BDI after inadvertent cannulation of the common bile duct (CBD). Application of this method has the potential to improve patient outcomes in two ways. Firstly, by limiting the degree of damage to the CBD, it may facilitate a simpler and more successful repair. Secondly, it provides a method of laparoscopic confirmation of BDI and, where laparoscopic hepaticojejunostomy is available, can entirely prevent the need for an open procedure.